Treatment of ARMD

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A recent American study corroborates the way the American Hospital of Paris has been treating Age-Related Macular Degeneration since November 2005.

 

The results of a comparative study on the treatment of Age-Related Macular Degeneration (ARMD) were published in May in the New England Journal of Medicine, the global reference in medical journals.

ARMD, in its “wet” form, leads to often rapid and, until recently, irreversible vision loss.  It is provoked by the development of abnormal vessels under the retina causing this part of the eye to deteriorate. 

In November 2005, the American Hospital of Paris began treating ARMD with intravitreal injections of Avastin®. This drug was recommended for the treatment of certain types of cancer and was eventually extended to the eyes through what is known as “off label” use. This is when a drug is used to treat a disorder other than the one for which it was marketed, provided there are enough scientific arguments to do so. This treatment had been initiated several months earlier in the United States, at the Bascom Palmer Eye Institute in Miami.

In July 2007, a drug derived from Avastin®, called Lucentis®, received approval for market introduction in France. It was specially packaged for ocular use but much more expensive than Avastin®.

The American study, which compared the results of each drug one year after treatment, demonstrates that both therapies are equally effective, thereby corroborating the initiative taken by the American Hospital of Paris in November 2005.

In addition, the study validates the legitimacy of the treatment protocol established by the  American Hospital of Paris for Avastin®, which it maintained for Lucentis®, in close collaboration with the Ophthalmological Unit and the Cardiology and Oncology Units, under the authority of the hospital’s Medical Affairs Division. First of all, our patients never received systematic injections, not when treatment was initiated or as part of follow-up care. Further treatment was only given when proven necessary by follow-up exams – at first monthly and then adapted to the individual relapse patterns of each patient, and based on the comparison of symptoms and supplementary exams (OCT and angiography). With over five years of hindsight today, the majority of our patients only received three to four injections per year, with extremes ranging from one to eight per year. And yet patients in the American study treated according to this flexible protocol benefitted from the same results as those receiving recurrent, systematic monthly treatment. 

Furthermore, the study examined the potentially serious cardiovascular accidents possibly related to these treatments. It confirms that such accidents are rare and reveal no significant difference between the two therapies, but that it is important to bear these accidents in mind and prevent them. In this respect, our protocol included from the outset a retina vessel examination aimed at identifying any associated cardiovascular risk factors. This allowed us to detect previously undiagnosed or insufficiently treated hypertension in 50% of our patients. 

The study, conducted under the sponsorship of the National Institute of Health, underscores the appropriateness of treating a complex multiple-factor disorder in a way that is at once innovative and personalized, in line with the mission of the American Hospital of Paris.  

 

Dr Claude Boscher - Ophthalmology Unit of the American Hospital of Paris


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